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كورس اللاب
كورس اللاب
https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.clinicallab.com
Course Outline
• Module 1:
Introduction to Clinical/ Medical Laboratory and the three Phases of Workflow
• Module 2:
Pre-Analytical Phase
• Module 3:
Analytical Phase
• Module 4:
Post Analytical phase
• General introduction to Clinical/ Medical Laboratory
o Hospital labs
o Non-Hospital Labs;
Stand Alone Labs
Reference Labs
oLab Director
oSupervisory Staff
oTesting Personnel
Clinical Laboratory Structure,
Work Area
Waiting Area
Phlebotomy Room
https://nursekey.com/patient-reception-and-processing-2/
Patient Reception https://www.bfwh.nhs.uk/our-services/pathology/departments/phlebotomy-outpatients
https://www.istockphoto.com/photos/hospital-reception
The Clinical Laboratory in a Hospital Setting
• The clinical laboratory in a hospital runs tests on patients that pertain to the
diagnosis, prevention and treatment of diseases.
• Although the laboratory is within the hospital, it generally does other testing aside
from tests conducted for the hospital.
•Specimen Processing: The area of the laboratory where all incoming specimens
are;
oSorted,
oAccessioned into the computer system of the laboratory,
oAppropriately labeled for transport to their respective departments for testing or
transport to reference labs.
Lab sections
Clinical Chemistry
• The Clinical Chemistry Laboratory is a state-of-the-art, fully automated laboratory.
• Tests performed on plasma, serum, urine and other body fluids such as CSF, synovial
• Or peritoneal fluids.
• Tests include but are not limited to sugar, lipid profile, kidney function tests and liver blood tests.
https://diagnostics.roche.com/
• Clinical Chemistry includes STAT and routine testing in the areas of general chemistry, endocrinology, special chemistry,
immunology and toxicology.
Lab sections
Clinical Chemistry
• The semi auto analyzer is characterized by its small size, simple structure and flexibility, and can be
used separately.
• At the same time, semi-automatic biochemical analyzers can be used in conjunction with other
medical equipment.
• The operator only needs to put the sample on the specific position of the
analyzer and choose the program to start the instrument to take the test
report.
https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.skalar.com
Lab sections
Clinical Immunology
• The Immunology Laboratory is responsible for tests that helps in the
evaluation of autoimmune disease, immunodeficiencies,
immunoproliferative disorders, and allergy.
https://www.istockphoto.com/photos/immunology
• The Clinical Hematology Laboratory performs a wide variety of basic and advanced hematology
testing.
o Routine hematology testing including complete blood count, blood differential, smear morphology
and bone marrow staining.
• Flow cytometry testing for lymphomas, leukemias, plasma cell neoplasms, etc..
https://www.youtube.com/watch?v=JRGqAavekiU
https://www.bdbiosciences.com/en-us/products/instruments/flow-cytometers/clinical-cell-analyzers/facscanto
• Advanced coagulation testing including hypercoagulability studies, coagulation factor and inhibitor
studies, platelet antibody and aggregation, antiphospholipid antibody testing, and others.
Lab sections
Microbiology
The Clinical Microbiology Laboratory offers diagnostic bacteriology, mycology, parasitology,
virology, and mycobacteriology.
• The microbiology section performs studies on various body tissues and fluids to determine
whether pathological microorganisms are present.
https://www.rch.org.au/specimen-collection/Blood_Culture/
• However, devices that automatically monitor the status of blood cultures are now being
used in many microbiology laboratories. https://www.researchgate.net/publication/306018042_Microbiology_Laboratory_Manual
Lab sections
Routine
• A frequently performed test that gives a general indication of the patient’s overall state
of health and more specifically the urinary tract.
https://www.youtube.com/watch?v=H2rb3pKJHWg
https://www.news-medical.net/health/Urine-Analysis-Urinalysis.aspx
• It is important to examine fresh specimens, otherwise cells and casts may disintegrate or
distort with bacterial infections.
Lab sections
Genetics
• The Division of Laboratory Genetics actively contributes to the study of genetic
disease and the advancement of genetic testing and related technology, with a goal of
enhancing clinical patient care.
o The Molecular Genetics Laboratory provides expertise in DNA and molecular genetic
testing for congenital disorders, infectious disorders and hematology/oncology.
https://biology.wustl.edu/explore-academics/molecular-genetics-genomics
Lab sections
Histopathology
• This section is related to the study of tissues.
https://www.google.com/url?sa=i&url=https%3A%2F%2Fdiagnostics.roche.com%2Fglobal%2Fen%2Fproducts%2Fproduct-category%2Fpoint-of-care-testing.
https://www.labmanager.com/laboratory-technology/managing-workflow-5185
• Lab workflows for sample management ensure that all steps and
requirements in a defined process are correctly implemented.
https://www.labmanager.com/laboratory-technology/managing-workflow-5185
https://cmpt.ca/extending-the-scope-of-eqa-to-the-extra-analytical-phases/
https://cmpt.ca/extending-the-scope-of-eqa-to-the-extra-analytical-phases/
• Definition of Pre-analytical phase of Clinical Laboratory Workflow
• Errors can occur at the time of patient assessment, test order entry,
request completion, patient identification, specimen collection, specimen
transport, or specimen receipt in the laboratory.
Pre-analytic phase
Concerning the preanalytical phase, laboratories should:
• Patient phone number/ e-mail : patient should insure that his/her phone number is
entered correctly through signing on the disclaimer on the request form to receive
his/her results via SMS or WhatsApp as well as the e-mail for online results.
Pre-analytic phase, Patient Reception
(e.g. fasting and after meal, fasting and after glucose load, before and after urea
capsule for urea breath test...etc.).
• For other samples that do not require phlebotomy, full instructions should be
either given to the patient for proper collection or the patient will be asked to
read them carefully inside the bathroom (e.g.: urine collection instructions).
Pre-analytic phase, Patient Reception
oMake sure to write the following information along with the original
information requirements:
• Patient’s age.
• Last Menstrual Period (LMP) date.
• Number of childbirths & abortions.
• Hormonal replacement therapy, if any.
• Fix the slide with 96% ethanol.
Types of Lab specimens
• Blood specimens
• Body fluids
• Swab specimens for culture
• PAP smear
• Histopathology tissue, fluids & FNA samples
Phlebotomy
Materials required for phlebotomy include;
• Needles: Any of the following needles can be used:
• Always make sure that the amount of blood you withdraw is relevant to
the tests required and sufficient for a back-up sample,
• Single tests do not require large amounts of blood as these excess amounts
need to be treated with care and caution when disposing for being
considered as hazardous materials.
• Do not draw blood from an arm that contains a fistula used for dialysis
patients.
• Some tests require special precautions during sample collection.; Always refere
to established procedures and text books if necessary.
Blood Collection for Adults
• Double check patient name by asking his/her name, and compare it with
barcodes.
• Apply a tourniquet (5-6 centimeters above the chosen site) and tighten slowly.
• Do not leave on for longer than one minute.
https://www.freepik.com/premium-photo/laboratory-assistant-preparing-patient-blood-analysis-
nurse-tightening-medical-tourniquet-arm-before-taking-blood-sample-concept-healthcare-
Blood Collection for Adults
• Ask the patient to open/close his/her fist then keep it closed.
• Palpate the site, mainly the median cubital vein, to check for rebound elasticity,
press lightly with two fingers and release, then choose the appropriate vein.
https://internationalbiosafety.org/wp-content/uploads/2019/08/How-to-Safely-Collect-Blood-Samples-Ebola.pdf
https://www.healthline.com/health/how-blood-is-drawn
• Disinfect the site using alcohol wet swab (preferably 70% isopropyl or ethyl
alcohol) in a circular motion starting from the center of the venipuncture site
and moving outwards to cover an area of 2 cm or more.
https://www.freepik.com/premium-photo/phlebotomist-disinfect-blood-collection-area-by-alcohol-pad-hospital-sample-
collection_26180787.htm
Blood Collection for Adults
• Place the used alcohol swab in the regular waste bin.
• For Blood Culture test, sterilize the venipuncture site with Povidone Iodine 10% as well as
the blood culture bottle lid for a minimum of 15 seconds and allow to air dry.
• Using your non-dominant hand to achieve skin traction, hold the syringe between your thumb
and index finger.
Blood Collection for Adults
• Position the needle, facing bevel upwards. Insert the needle directly above the vein, through
the skin (angle 10-30°).
https://www.youtube.com/watch?v=7NSEFVbzTAU
• Care should be taken not to enter too fast and too deep otherwise the needle can go
through the back of the vein
• When using the syringe, pull the plunger back slowly until the blood body is filled.
• When multiple blood tests are required, ensure the blood tests are taken in the proper
order of draw as follow:
Phlebotomy order of Draw
https://www.pinterest.com/jop0197/phlebotomy-order-of-draw/
Blood Collection for Adults
• If no blood can be obtained, remove the blood tube (if vacutainer system is
used), loose the tourniquet, apply dry swab over the puncture site and remove the
needle.
• Place the syringe needle in the sharps box and place the syringe body in
biohazard waste bin.
• Maintain the pressure using the dry swab, put the plaster.
• For the second attempt, seek further help from a more experienced person.
Blood Collection for Adults
• Through the blood collection procedure, always observe the patient for
signs of paresthesia, fainting or dizziness.
• For a second attempt, repeat the steps above and collect blood.
• After blood collection, loosen and release the tourniquet. Invert the
bottles gently. Do not shake the bottles.
Blood Collection for Adults
Use the following diagram for blood inversion and the order of
blood draw diagram for the number of inversions for each tube.
Blood Collection for Adults
• Apply dry swab over the puncture site and remove the needle.
• Maintain a slight pressure on the puncture site to prevent blood leakage. Arm can be elevated
while applying pressure to prevent hematoma formation but do not bend the arm.
• Discard the blood contaminated gauze in the biohazard waste bin. Apply plaster over the
puncture site.
• Label the tubes collected with patient barcodes, which should include at least 2 identifiers.
Blood Collection for Adults
• Remove the gloves and place them in the biohazard waste bin.
• Ask the patient about the experience and if he is feeling well before standing up and leaving the
phlebotomy room.
• Join the patient when leaving out of the phlebotomy room and wish him to get will soon.
• MT initial should be written on the request form on (sample drawn by) space.
• In rare cases where the barcodes are not generated before sample collection (for a
justifiable reason), samples must be labelled with at least two identifiers; patient name and
date of birth. Samples must be tracked with MT initials.
Children and Neonates Phlebotomy Procedure
• Ask the children father or mother to sit on the phlebotomy chair and tightly hold the
child.
• Make sure that the children sit in suitable position and ask for another MT to hold the
child’s arm.
• Withdraw the blood using the same procedure for adults’ blood withdrawal
• If the baby is less than 6 months, put the baby on baby’s bed and ask for help from
another MT to hold his/her arm.
• Withdraw the blood using the same procedure for adults’ blood withdrawal.
Neonatal screen Phlebotomy procedure
• Gently massage baby’s heel to increase blood flow.
https://www.hurleymc.com/files/laboratory/capillary-microphlebotomy-collection-technique.pdf
• Sterilize baby’s heel using alcohol swab and let it air dry.
https://www.alibaba.com/product-detail/Red-and-Yellow-plastic-bags-for_62022409400.html
Troubleshooting Guidelines
If an incomplete collection or no blood is obtained
• Try another tube. There may be no vacuum in the one being used.
• Re-anchor the vein. Veins sometimes roll away from the point of
the needle and puncture site.
Troubleshooting Guidelines
If blood stops flowing into the tube
• The vein may have collapsed; re-secure the
tourniquet to increase venous filling.
• If this is not successful, remove the needle, take
care of the puncture site, and redraw.
• The needle may have pulled out of the vein when switching
tubes.
• Hold equipment firmly and place fingers against patient's
arm, using the flange for leverage when withdrawing and
inserting tubes.
Patient Problems/ Adverse Reactions
Hematoma
https://www.healthline.com/health/what-is-a-contusion
To prevent hematoma when
collecting a blood specimen
• Remove the tourniquet before removing the needle.
• Use the major veins if possible (i.e. median cubital or cephalic veins, basilic vein,
not superficial veins). Hand veins are very prone to the formation of hematoma.
• Puncture only the uppermost wall of the vein. Going completely through the
vein may allow blood to leak out through the back wall of the vein into the
tissues.
To prevent hematoma when
collecting a blood specimen
• Make sure the needle fully penetrates the uppermost wall of the vein. Blood may leak
out around the bevel if the needle is not fully inserted into the vein.
• Apply pressure to the venipuncture site with gauze and have the patient elevate his/her
arm.
• If the patient is on anticoagulant therapy, apply a pressure bandage and caution the
patient to leave it on for at least 15 minutes.
• If a hematoma formed under the skin adjacent to the puncture site, release the
tourniquet immediately and withdraw the needle and apply firm pressure.
Patient Problems/ Adverse Reactions
Fainting
• Fainting tends to occur in normal individuals during emotional
stress or during pain, fever, prolonged bed rest, poor physical
condition, anemia, organic heart disease and fasting are all
conditions which may increase patient’s susceptibility to fainting.
• Never draw blood from a patient who is standing. In this position, the patient is
more likely to faint and injure him/ herself as a result.
• If using a phlebotomy chair with a protective arm, keep it closed for support of
the patient in case he/she faints and slumps forward.
• If the patient is sitting in a chair without a protective arm, stay directly in front
of the chair so one can catch the patient if he/she faints and slumps forward.
Patient Problems/ Adverse Reactions
Nausea & Vomiting
• Nausea
Make the patient comfortable.
Instruct the patient to breath, deeply and slowly.
Apply a cold towel to patient’s forehead and back of the neck.
• Vomiting
Give the patient an emesis bag and have tissues ready.
Give the patient water to rinse out his/her mouth upon request.
Patient Problems/ Adverse Reactions
Convulsions or Seizures
• Convulsions or seizures are involuntary muscular contractions of varying
degrees.
• They are the result of abnormal electrical impulses occurring within the
brain. This causes a loss of consciousness and convulsive movement.
How to deal with Convulsions or Seizures
• Do not attempt to restrain the movements of the patient.
• In case of epileptic seizures, try to keep patient’s mouth open or hold the tongue, this is done to
prevent the patient from biting/swallowing his/her tongue.
Patient Problems/ Adverse Reactions
Accidental Arterial Puncture
• Apply firm pressure to the venipuncture site for a minimum of 10 minutes. Do not even
look under gauze until ten minutes have passed.
• If bleeding has ceased after this time period apply a band aid, and instruct the patient not
to perform any strenuous activity (i.e. physical activity or picking children).
Specimen Rejection Criteria include but not limited to;
• Processing of specimens
• Instrument Maintenance
https://radwag.com/en/as-110-r2-plus-analytical-balance
Other Laboratory Equipment
• Refrigerators
• Freezers
laboratory-refrigerator-labex-468
https://www.labmanager.com/product-focus/how-to-ensure-proper-maintenance-of-refrigerators-and-freezers-
• Water baths
• PH meter https://www.munroscientific.co.uk/the-complete-guide-to-working-in-a-laboratory-water-bath
• Incubators https://www.amazon.com/Fristaden-Lab-Benchtop-Scientific-Electrode/dp/B089LKXS65
• Thermometers
https://www.indiamart.com/proddetail/mercury-red-alcohol-filled-glass-thermometers-22605982012.html
https://www.carolina.com/incubators-and-ovens/incubator-lab-07-cubic-ft-capacity/701296.pr
Other Laboratory Equipment
• Microscope:
o A delicate & expensive instrument,
o Special care must be taken in its use
o Various types
https://www.microscope.com/motic-ba310bp-binocular-polarizing-compound-microscope.html
o Light microscopes:
Bright field
Phase contrast
Fluorescence
o Electron microscope
Analytic phase, Specimen Preparation for Testing:
• Centrifuges
https://www.youtube.com/watch?v=0JcvGsGrWqs
https://www.medicalexpo.com/prod/deltalab/product-68179-865180.html
Instrumentation
*Processing
• Plain tubes: Wait 20 to 30 minutes to assure complete clotting, centrifuge at 4500 rpm
for 10 minutes.
Note: Centrifugation must be completed within the above specified time taking in
consideration the special test requirement and patient history.
• EDTA tubes: Blood samples in EDTA tubes are whole blood samples that are not
centrifuged but used for whole blood tests such as CBC, HbA1C and others.
• Plasma from EDTA and Heparin tubes: centrifuge the tube at 4500 rpm for 10
minutes.
• Always refer to Lab Ps&Ps and or kit inserts for specific tests
Instrumentation
*Processing
Specimen Aliquoting:
• For proper aliquots and to ensure traceability, a barcode pre-labeled tube with patient name and
specimen number and type are placed in a separate rack and the supernatant of the original
centrifuged tube is transferred by a pipette to the pre-identified plastic tube.
• Write your initials on the aliquoted tubes and double check patient name, visit number, and sample
type with the original tube.
• Make sure not to aliquot more than one patient specimen at the same time.
Instrumentation
*Maintenance
Various procedures and routines will ensure that your laboratory equipment is
well-maintained and cared for, this includes;
• The SOP can be written by the lab manager, an equipment officer, or staff that
frequently works with the specific equipment.
• At least two levels of controls must be run with each batch of patient samples or per shift and/ or as per the
kit/ instrument/ manufacturer’s recommendations.
• All control runs must be filed in the appropriate control file for review/ documentation.
• Patient results must not be reported unless the appropriate quality controls defined for the procedure are run
and are found to be within acceptable range.
Instrumentation
*Quality Control
• All unacceptable control runs must be recorded on Controls falling outside acceptable limit
log sheet for tracking and appropriate follow up.
• Daily- all QC results must be reviewed by the technologist with regular review by the area
senior/ supervisor/lab director to determine if they meet the acceptability criteria.
• Section Heads/ Directors or designees must review all control data at least on monthly
basis.
Instrumentation
*Calibration
• Calibration is usually the responsibility of the biomedical engineer rather than the
technologists.
https://www.indiamart.com/proddetail/laboratory-equipment-calibration-services-17864741855.html
• Regular calibration of laboratory equipment should be done because over time, biases
develop in relation to the standard unit of measure.
Instrumentation
*Troubleshooting
• Result Reporting
• Waste Management
Post-analytic phase
• In the post-analytic phase, results are reviewed and released to the clinician, who
interprets them and makes diagnostic and therapeutic decisions.
• report STAT results and critical values promptly and have a written quality
assurance program.
• generate Levy-Jennings or trend plots of QC results to identify changes in test
performance.
• accurately transmit test results.
• reduce human error through root-cause analysis, process control, and
education/communication.
Result Reporting
• Depending on lab internal workflow, result entry section will receive worksheets with the
results of the requested tests signed from the medical technologist who performed the
testing.
• Results will be automatically transferred from the machine to the LIS system (interface),
except for certain calculated and manual tests.
• MT will check results on the LIS system for any mistakes, confirmation, calculation, and
manual tests entry.
• Results will be released and submitted for review & finalization by the lab Director.
Result Reporting
The final result report must include the following elements as applicable:
• Name and address of testing laboratory.
• Patient name and identification number.
• Name of physician or referring source.
• Date and time of specimen collection.
• Date and time of results reporting.
• Specimen source.
• Test results with units, reference intervals based on age and gender.
• Name and signature of Laboratory director.
• Any condition of specimen that may effect the test result or adequacy of
testing.
Result Reporting
• Results reviewed by the lab Director must insure that all unusual or
unexpected results are investigated and confirmed before reporting.
• The review will ensure that the results are matched clinically with patient age,
sex, and history of any previous results on patient’s file.
• The review will ensure that all quality control, quality assurance steps have
been done according to established policies including the handling of any
abnormal or critical results.
Result Reporting
• In the event where the results are delayed for any reason, patient must be
communicated and informed.
Communication of critical results
• The read back policy requires that the patient receiving the critical
result repeats it back to ensure that the communicated result has
been received accurately by the receiving party.
Communication of critical results
The documentation shall include:
• The clinician must also evaluate the result from the knowledge of biological
variation and be aware of the potential risk of false interpretation.
All used tubes, expired tubes, used needles, gloves and other types of
phlebotomy wastes should be disposed of properly and according to
the standards in waste disposal procedure .
https://www.asterhospitals.in/bio-medical-waste-report https://celitron.com/en/medical-sharps-waste-disposal-iss
MOH Regulations/ Waste Disposal
https://moh.gov.jo/
Waste Disposal &
Local Regulations
Waste Disposal &
Local Regulations
https://www.medlabsgroup.com
Waste Disposable&
Local Regulations
All bags or containers must be:
• Tightly sealed
• Compatible with their components
• Filled to a safe level
• Labeled with lab Name, Weight & Date
Thank You
rabed@medlabsgroup.com